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25 Cards in this Set
- Front
- Back
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very low RBC, Hgb, Hct
very high MVC |
hemolyic anemia
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peripheral smaer
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polychromasia (mult-colored)
spherocytes (reticulocytes-new RBCs) nucleated RBC |
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history clues
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good nutrition
normal menses recent illness |
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RBC smear
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macrocytic (large cells) normochromic (normal color) anemia
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marrow response to RBC loss
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dramatic capacity to increase RBC production (by 6-10 times normal rate)
increase in reticulocytes-young, large RBC |
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mcv elevation
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hemolytic anemia
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mechanisms of anemia
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decreased production
increased destruction distinguish b/t w/ measurement of reticulocyte proportion |
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reticulocyte count
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elevated-appropriate response (increased destruction/decreased survival)
low/normal-impaired/decreased production |
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hemolytic anemias
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destruction of RBC faster than marrow can replace them
classified according to mechanism and location of RBC destruction |
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location of RBC destruction
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intravascular-rapid destruction of RBC while in circlation (releases contents into circulation-toxic due to Hgb in plasma
extravascular-removal of RBC by reticuloendothelial system and macrophage disgestion (more common and less dangerous-slower destruction rate) |
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abnormalities of RBC cytoplasm (inherited)
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enzyme defects
hemoglobinopathies |
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RBC membrane abnormalities
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hereditary spherocytosis (inherited)
paroxysmal nocturnal hemoglobinuria (inherited) spur cell anemia (acquired) |
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extrinsic factors (acquired)
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hypersplenism
Ab: immune hemolysis microangiopathic hemolysis infections, toxins, mechanical |
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RBCs change to spherocytes due to loss of membrane
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hereditary spherocytosis
autoimmun hemolytic anemia |
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clinical feature
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hereditary-hyperbilirubinemia w/ possible jaundice
autoimmune-gradual fatigue palor, splenomegaly dark urine (tea colored)-from urine bilirubin |
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warm Ab
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IgG (idiopathic or drug induced)
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cold Ab
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IgM-due to cold agglutinin disease or secondary infection
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coombs test
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detecting Abs to RBCs
direct-Ab bound to RBC surface indirect-Ab circulating in serum that's reactive to RBC surface components |
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what accumulates in uncongugated form when large amounts of heme are released?
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bilirubin
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serumm scavenger of free hemoglobin-cleared by liver when bound
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haptoglogin
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purple hued young RBC, reflecting increase marrow prodcution
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polychromatophilia
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storage Fe sloughed into urine from Fe overloaded in renal tubule cell
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hemosiderin
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elevated MCV
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round macrocytes (hemolysis)
oval macrocytes (vit. deficiency, MDS) |
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increased reticulocyte count
increased LDH low haptoglobin increased bilirubin Coomb' direct-IgG positive |
autoimmune hemolytic anemia
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treatment
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suppress immune system
1. steroids 2. splenectomy 3. monoclonal anti-lymphocyte Abs (anti-CD20) 4. chemotherapy |
